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General NPI Number Information
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NPI Number | 1114386125
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Entity Type | Organization
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Legal Business Name | AFFINITY COUNSELING AND FAMILY LIFE SERVICES, LLC
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 10632 LITTLE PATUXENT PKWY SUITE 343
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City | COLUMBIA
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State | MD
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Zip | 21044-3273
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Country | US
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Telephone | 888-737-3330
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Fax |
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Provider Business Mailing Address
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Address Line | 10632 LITTLE PATUXENT PKWY SUITE 343
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City | COLUMBIA
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State | MD
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Zip | 21044-3273
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Country | US
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Telephone | 888-737-3330
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIMBERLY VAN PUTTEN-GARDNER
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Credential | PH.D.
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Telephone | 301-317-8050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LC4143
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License Number State | MD
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